Kim, Tana

INTRODUCTION: Obesity is associated with lower pregnancy and live birth rates following in vitro fertilization (IVF). As the follicular fluid (FF) provides the microenvironment for the oocyte, immune dysregulation due to obesity related inflammation could disrupt the developing oocyte. The objective of this study was to compare differences in FF cytokines based on BMI in women undergoing IVF. METHODS: FF was collected from women undergoing IVF. Cytokines levels were measured from the FF using ELISA and compared based on BMI ≥35. Patient characteristics and cycle outcomes were compared between the groups. Wilcoxon rank sum and Fisher exact tests were used for continuous and categorical variables, respectively. Values are presented as medians. RESULTS: The analysis included 57 women with BMI <35 and 11 women with BMI ≥35. Women with BMI ≥35 had higher levels of IL-6 (129.23 vs 16.55 pg/mL, P=.019) and TNF-α (62.6 vs 9.54 pg/mL, P=.037) in the FF. Anti-müllerian hormone was lower with BMI ≥35 (2.0 vs 3.6 ng/mL, P=.049), but no other differences in patient characteristics were seen between the groups. There were no differences in stimulation duration (11 vs 11 days; P=.993), total gonadotropin (3075 vs 2475 units; P=.122), peak estradiol (2080 vs 1972 pg/mL, P=.521), mature oocytes (13 vs 12; P=.822), and oocyte maturity rate (82% vs 80%, P=.653) between the groups. CONCLUSION: Obese women undergoing IVF have higher levels of inflammatory cytokines IL-6 and TNF-α in the FF. These biochemical discrepancies may provide early insight into pathophysiologic differences in oocyte development in obese women undergoing IVF.

INTRODUCTION: Testicular sperm extraction (TESE) has traditionally been reserved for couples with azoospermia. However, recent data suggests TESE may be beneficial for men with abnormal semen parameters without azoospermia. The objective of this study was to compare in vitro fertilization (IVF) outcomes between TESE and ejaculated sperm (ES) for non-azoospermic male factor infertility. METHODS: Following IRB exemption, couples undergoing IVF for non-azoospermic male factor infertility with total motile sperm (TMS) <25 million motile/ejaculate from 1/2016 to 1/2019 were included. Men were grouped by whether TESE or ES was utilized for insemination. Couple characteristics and cycle outcomes were analyzed. Wilcoxon rank sum and Fisher exact tests were utilized as appropriate. Values are reported in medians. RESULTS: The analysis included 36 men who utilized ES and 23 men who utilized TESE. The median female age was 32 while the median male age was 35 with ES and 37 with TESE. TMS (6.1 vs 3.9 million motile/ejaculate, P=.46), motility (40% vs 30%, P=.07), and strict morphology (2.5% vs 1.0%, P=.15) were similar between ES and TESE. The total mature oocytes retrieved was similar between the groups but compared to ES, TESE was associated with 20% decrease in fertilization (80.6% vs 60.0%, P=.02) and half the number of blastocyst embryos (4 vs 2 embryos, P=.02). Although not statistically significant, TESE also had >10% decrease in live birth (48.5% vs 36.8%, P=.56). CONCLUSION: TESE is associated with lower fertilization and blastocyst embryos as well as decreased live birth rates compared to ES use for non-azoospermic male factor infertility.